Take Control, Empower Yourself and Achieve Management of Asthma (CALMA)

The CALMA
program aims to help Puerto Rican families manage their children’s asthma. This
involves sending trained counselors into homes and teaching families in a
culturally sensitive way about the disease and how to manage it. The program
increased families’ and caregivers’ confidence in their ability to manage their
children’s asthma, reduced hospital visits, and increased children’s control of
their asthma. However, there was no impact on how often the disease limited the
children’s activity, nor on the frequency of asthma attacks.

DESCRIPTION OF PROGRAM

Target
population:
Low-income
Puerto Rican children with asthma.

Take Control, Empower Yourself and Achieve Management of Asthma (CALMA)
is a
home-based, culturally sensitive, family education program to improve asthma
management. It is designed to help Puerto Rican families learn how to better
manage their children’s asthma. Specifically, the program aims to decrease
asthma symptoms and hospital visits, and to help families feel more confident in
their ability to understand and control the disease. Trained asthma counselors
come into the family’s home to teach them about the disease, how to notice early
symptoms, and the proper way to use prescribed medications, among other things.
There are eight lesson modules, delivered over two sessions, with telephone
contacts for ongoing follow-up. The families are also given a manual with the
information, to keep as a reference.

The lesson
modules cover a wide number of topics. They aim to help the family understand
the nature of asthma, the medications that are prescribed, and how to
effectively use the health care system. Additionally, the counselors help the
family figure out what is preventing proper treatment in their own situation.
They also teach proper use of medications, how to identify asthma triggers and
early symptoms, and how to use action plans. All of this is done in an
environment in which the family feels understood and free to share cultural
beliefs and practices.

Evaluated
population:A total of 221 children and their families in Puerto Rico were evaluated. All
children were 5 to 12 years old, had poor asthma control, and received health
insurance from the government of Puerto Rico, which is only available to
families with incomes up to two times the poverty level. Seventy-five percent
of the families received social assistance (welfare).

Approach:
Families
were assigned to either the treatment or control group through a mixed-block
randomization scheme, ensuring some consistency of baseline characteristics
between the treatment and control groups. After randomization, families in the
treatment group received the program described above, while those in the control
group received flyers in the mail that gave information about asthma
management. The flyers were not designed with Puerto Rican culture in mind, and
there was no follow-up or opportunity to ask questions, in contrast with the
in-person teaching sessions.

Data were
collected at baseline and at follow-up four months later. The researchers
interviewed the families to measure the severity and frequency of children’s
asthma symptoms, the degree of control the child had over the asthma, the
caregivers’ quality of life, and how empowered the caregiver was to act in an
emergency or advocate for proper treatment.

Results:CALMA had no significant impact on the number of symptom-free days, limits on
the child’s activity, or the use of medication. There were significant impacts
on the number of symptom-free nights, though the reductions were not sufficient
to be clinically significant. In the most-highly significant results, the CALMA
children were more likely than their control-group peers to have their treatment
under control, less likely to visit a hospital emergency department, and less
likely to be hospitalized.

The caregivers in the treatment group were less likely to report feeling
helpless, frustrated, or upset because of their child’s asthma; more likely to
feel confident in their ability to manage the disease; and more likely to feel
knowledgeable about their child’s asthma. There was no impact on their
perceived empowerment to deal with the health care system.